Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: A cluster randomized controlled trial

Jordans M.J.D., Komproe I.H., Tol W.A., Kohrt B.A., Luitel N.P., Macy R.D., Jong J.T.V.M.

Journal of Child Psychology and Psychiatry

Published on: 21 January 2010

Background: In situations of ongoing violence, childhood psychosocial and mental health problems require care. However, resources and evidence for adequate interventions are scarce for children in low- and middle-income countries. This study evaluated a school-based psychosocial intervention in conflict-affected, rural Nepal.

Methods: A cluster randomized controlled trial was used to evaluate changes on a range of indicators, including psychiatric symptoms (depression, anxiety, post traumatic stress disorder), psychological difficulties, resilience indicators (hope, pro-social behavior) and function impairment. Children (= 325) (mean age = 12.7, SD = 1.04, range 11–14 years) with elevated psychosocial distress were allocated to a treatment or wait list group.

Results: Comparisons of crude change scores showed significant between-group differences on several outcome indicators, with moderate effect sizes (Cohen = .41 to .58). After correcting for nested variance within schools, no evidence for treatment effects was found on any outcome variable. Additional analyses showed gender effects for treatment on pro-social behavior (mean change difference: 2.70; 95% CI, .97 to 4.44), psychological difficulties (−2.19; 95% CI, −3.82 to −.56), and aggression (−4.42; 95% CI, −6.16 to −2.67). An age effect for treatment was found for hope (.90; 95% CI, −1.54 to −.26).

Conclusions: A school-based psychosocial intervention demonstrated moderate short-term beneficial effects for improving social-behavioral and resilience indicators among subgroups of children exposed to armed conflict. The intervention reduced psychological difficulties and aggression among boys, increased pro-social behavior among girls, and increased hope for older children. The intervention did not result in reduction of psychiatric symptoms.


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